Annals of Occupational and Environmental Medicine

Research Article

A study on the characteristics of Maslach Burnout Inventory-General Survey (MBI-GS) of workers in one electronics company: Young Gon Choi, Byung Jin Choi, Tae Hwi Park, Jun Young Uhm, Dong Bae Lee, Seong Sil Chang, Soo Young Kim; Ann Occup Environ Med 2019;31:e29. Published online October 15, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e29

Background

This study investigated characteristics according to demographic, occupational factors of Maslach Burnout Inventory-General Survey (MBI-GS) and related scales to MBI-GS.

Methods

The subjects of the study were 3,331 workers in 3 different workplaces of one electronics company. They filled in demographic factors surveys, occupational factors surveys, MBI-GS, Korean Occupational Stress Scale-Short Form (KOSS-SF), Patient Health Questionnaire-9 (PHQ-9), and World Health Organization Quality Of Life-Abbreviated version (WHOQOL-BREF). The correlations between sub-scales of MBI-GS and KOSS-SF, PHQ-9, WHOQOL-BREF were analyzed respectively. And KOSS-SF, PHQ-9, and WHOQOL-BREF were categorized; mean scores of sub-scales of MBI-GS were compared; and the quartiles of sub-scales of MBI-GS were presented.

Results

A comparison of mean scores of MBI-GS according to demographic and occupational factors showed a significant difference according to age, problem drinking behavior, working time, and working duration in exhaustion regardless of sex. In professional efficacy, a significant difference was observed in age, marital status, working type, and working duration. And as a result of correlation analysis, the correlation coefficient between exhaustion and PHQ-9 was the highest regardless of sex. In addition, regardless of sex, exhaustion and cynicism scores tended to increase and professional efficacy score tended to decrease as the work stress level rose. Same tendency is shown in case of the more severe the symptom of depression and the lower quality of life. When the quartile for sub-scales' score of MBI-GS were investigated, the burnout was more pronounced in female than in male.

Conclusions

Many demographic and occupational factors affect burnout were identified in one electronics company, and we investigated which sub-scales of MBI-GS were affected. Through this study, burnout characteristics were identified in a few population group of Korea, and the results are expected to be useful for burnout risk group identification, counseling, etc.

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Research Article

The association between shift work and chronic kidney disease in manual labor workers using data from the Korea National Health and Nutrition Examination Survey (KNHANES 2011–2014): Jun Young Uhm, Hyoung-Ryoul Kim, Gu Hyeok Kang, Young Gon Choi, Tae Hwi Park, Soo Young Kim, Seong Sil Chang, Won Oh Choo; Ann Occup Environ Med 2018;30:69. Published online December 14, 2018; DOI: https://doi.org/10.1186/s40557-018-0279-z

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Objective

Kidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset.

Methods

This study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/or estimated glomerular filtration rate lower than 60 mL/min/1.73 m². The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender.

Results

The risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2.34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant.

Conclusions

In this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.

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Research Article

Environmental exposure of heavy metal (lead and cadmium) and hearing loss: data from the Korea National Health and Nutrition Examination Survey (KNHANES 2010–2013): Gu Hyeok Kang, Jun Young Uhm, Young Gon Choi, Eun Kye Kang, Soo Young Kim, Won Oh Choo, Seong Sil Chang; Ann Occup Environ Med 2018;30:22. Published online April 17, 2018; DOI: https://doi.org/10.1186/s40557-018-0237-9

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Background

Lead and cadmium have been identified as risk factors for hearing loss in animal studies, but large-scale studies targeting the general human population are rare. This study was conducted to investigate the link between heavy metal concentrations in blood and hearing impairment, using a national population-based survey.

Methods

The study participants comprised 6409 Koreans aged 20 or older, who were included in the Fifth and Sixth Korea National Health and Nutrition Examination Surveys (KNHANES 2010–2013). Hearing impairment was categorized into two types, low- and high-frequency hearing impairment, using pure tone audiometry. Low-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 0.5, 1, and 2 kHz exceeding 25 dB, and high-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 3, 4, and 6 kHz exceeding 25 dB. The blood levels of heavy metals (lead and cadmium) were classified into quartiles. Cross-sectional association between hearing impairment and the level of heavy metals (lead and cadmium) was examined in both sexes. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Among men, the prevalence of low- and high- frequency hearing impairment was 13.9% and 46.7%, respectively, which was higher than the prevalence among women (11.8% and 27.0%, respectively). Regarding lead, the adjusted OR of high-frequency hearing impairment for the highest blood level group versus the lowest group was significant in both men (OR = 1.629, 95% CI = 1.161–2.287) and women (OR = 1.502, 95% CI = 1.027–2.196), after adjusting for age, body mass index, education, smoking, alcohol consumption, exercise, diagnosis of diabetes mellitus, hypertension, and noise exposure (occupational, loud, firearm noises). No links were found between blood lead levels and low-frequency hearing impairment, or between blood cadmium levels and low- or high-frequency hearing impairment in either sex.

Conclusions

The present study findings suggest that even exposure to low-level lead is a risk factor for high-frequency hearing loss. A prospective epidemiologic study should be conducted to identify the causal relationship between human health and exposure to heavy metals, and efforts to reduce heavy metal exposure in the general population should continue.

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Sang-Yoon Han, Sang-Yeon Lee, Myung-Whan Suh, Jun Ho Lee, Moo Kyun Park
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Ear & Hearing.2023;[Epub] CrossRef
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Jennifer Galdieri, Chloe Adams, María Padilla, Tamara M. Stawicki
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Mingming Liang, Xianwei Guo, Xiuxiu Ding, Qiuxia Song, Hao Wang, Ning Li, Wanying Su, Qiwei Liang, Yehuan Sun
Ecotoxicology and Environmental Safety.2022; 247: 114279. CrossRef
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Research Article

Association between shift work and microalbuminuria: data from KNHANES(2012–2014): Eun Kye Kang, Gu Hyeok Kang, Jun Young Uhm, Young Gon Choi, Soo Young Kim, Seong Sil Chang, Hyoung-Ryoul Kim; Ann Occup Environ Med 2017;29:37. Published online August 21, 2017; DOI: https://doi.org/10.1186/s40557-017-0194-8

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Background

Shift work disturbs workers’ biological clocks and this condition can cause various health problems including cardiovascular disease. The elevated albuminuria level has been significantly associated with the risk of the cardiovascular disease even within a normal reference range. Therefore, this study aimed to investigate the association between shift work and microalbuminuria.

Methods

Workers aged over 20 years from the fifth and sixth Korea National Health and Nutrition Examination Survey(KNHANES 2012–2014; n = 3000) were included in this analysis. The multiple logistic regression analysis was performed to determine the association between shift work and microalbuminuria stratified by gender.

Results

The prevalence of microalbuminuria in male subjects was higher among day workers, but the difference was not significant. However, the prevalence of microalbuminuria among females was higher in shift workers with statistical significance. For female, the Odds ratio of microalbuminuria in shift workers was significantly higher with 1.86 (95% CI 1.02–3.39) compared with day workers. After dividing into 5 subgroups of the shift work pattern, the odds ratio of microalbuminuria for fixed night shift was significantly higher at 4.68 (95% CI 1.29–17.00) compared with day workers.

Conclusions

This study showed that shift work was associated with microalbuminuria in female workers. Especially we found out the association between fixed night shift and microalbuminuria in female workers.

Citations

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Cardiometabolic traits mediate the association of past shift work and chronic kidney disease: the Dongfeng–Tongji cohort study
Xu Han, Fei Wang, Jing Wang, Meian He
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Rotating Night Shift Work, Exposure to Light at Night, and Glomerular Filtration Rate: Baseline Results from a Chinese Occupational Cohort
Shengkui Zhang, Yongbin Wang, Ying Zhu, Xiaoming Li, Yang Song, Juxiang Yuan
International Journal of Environmental Research and Public Health.2020; 17(23): 9035. CrossRef

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Research Article

Evaluation of the dermatologic life quality among cleanroom workers in a secondary battery factory: Jae Jung Cheon, Jun Young Uhm, Gu Hyeok Kang, Eun Gye Kang, Soo Young Kim, Seong Sil Chang; Ann Occup Environ Med 2016;28:39. Published online September 2, 2016; DOI: https://doi.org/10.1186/s40557-016-0125-0

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Background

Cleanroom air is extremely dry, as it is maintained within 1 % of relative humidity. Few studies have assessed the dermatologic life quality of workers in ultralow-humidity environments. Therefore, we aimed to evaluate the dermatologic life quality of cleanroom workers using the Skindex-29, compared to those of non-cleanroom workers.

Methods

Study participants were 501 cleanroom workers and 157 non-cleanroom workers from a secondary battery factory, who underwent an employee health examination at a single university hospital from September 2014 to September 2015. Results of the self-administered Skindex-29, and McMonnies questionnaire were analyzed. Other information and disease history were also collected during physician's medical examination. Descriptive and multivariate logistic regression analysis were performed.

Results

The Skindex-29 score was significantly higher in cleanroom workers than in non-cleanroom workers for all domains, Symptom (16.0 ± 15.9 vs. 6.3 ± 10.2, p < 0.001), Emotion (11.3 ± 17.4 vs. 2.5 ± 7.4, p < 0.001), Function (5.2 ± 11.1 vs. 1.6 ± 4.0, p < 0.001), and Overall (10.8 ± 13.4 vs. 3.5 ± 6.2, p < 0.001). The Skindex-29 score of cleanroom workers was similar to that of patients with skin diseases such as psoriasis, other dermatitis, corns, alopecia etc. Among the cleanroom workers, 37 workers had one or more skin diseases.

Among the risk factors, ‘working at cleanroom’, ‘possessing skin disease’ and ‘McMonnies score’ had significant strong correlations with Skindex-29 score, meanwhile age, sex, smoking, drinking and exercise had weak correlations with it.

‘Working at cleanroom’ and ‘possessing skin disease’ had highest odds ratios with overall 14.0 (C.I.: 5.9–33.1) and 13.4 (C.I.: 4.5–29.2), and the lowest odds ratios with function domain 3.5(C.I.: 1.7–7.1) and 4.5(C.I.: 2.1–9.5), respectively. The McMonnies score had the highest odds ratio with overall, 6.9(C.I.: 4.5–10.8) and lowest odd ratio with emotion domain 4.2 (C.I.: 2.7–6.4).

Conclusions

Dermatologic life quality among cleanroom workers in the secondary battery factory is shown to be lower than that among non-cleanroom workers in this study. The study suggests that the Skindex-29 may provide helpful information on the dermatologic life quality of cleanroom workers. Therefore, regarding evaluation of dermatologic life quality using Skindex-29, preventive care is necessary for cleanroom workers in ultralow humidity environment.

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Association Between Shift Work and Clean Room Environment on Self-reported Premenstrual Symptoms and Menstrual Pain in Taiwan
Su-Ying Tsai
Safety and Health at Work.2024; 15(3): 278. CrossRef

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Research Article

Prevalence of Dry Eye Syndrome after a Three-Year Exposure to a Clean Room: Hyun A Cho, Jae Jung Cheon, Jong Seok Lee, Soo Young Kim, Seong Sil Chang; Ann Occup Environ Med 2014;26:26-26. Published online September 3, 2014; DOI: https://doi.org/10.1186/s40557-014-0026-z

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Objective

To measure the prevalence of dry eye syndrome (DES) among clean room (relative humidity ≤1%) workers from 2011 to 2013.

Methods

Three annual DES examinations were performed completely in 352 clean room workers aged 20–40 years who were working at a secondary battery factory. Each examination comprised the tear-film break-up test (TFBUT), Schirmer’s test I, slit-lamp microscopic examination, and McMonnies questionnaire. DES grades were measured using the Delphi approach. The annual examination results were analyzed using a general linear model and post-hoc analysis with repeated-ANOVA (Tukey). Multiple logistic regression was performed using the examination results from 2013 (dependent variable) to analyze the effect of years spent working in the clean room (independent variable).

Results

The prevalence of DES among these workers was 14.8% in 2011, 27.1% in 2012, and 32.8% in 2013. The TFBUT and McMonnies questionnaire showed that DES grades worsened over time. Multiple logistic regression analysis indicated that the odds ratio for having dry eyes was 1.130 (95% CI 1.012–1.262) according to the findings of the McMonnies questionnaire.

Conclusions

This 3-year trend suggests that the increased prevalence of DES was associated with longer working hours. To decrease the prevalence of DES, employees should be assigned reasonable working hours with shift assignments that include appropriate break times. Workers should also wear protective eyewear, subdivide their working process to minimize exposure, and utilize preservative-free eye drops.

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Review

Local occupational disease surveillance system in Korea: Current status and issues: Jong Han Leem, Seong Sil Chang, Seong Ah Kim, Jai Dong Moon, Chang Ho Chae, Yun Chul Hong, Soo Young Kim, Jin Seok Kim, Young Wook Kim, Sang Hwan Han, Hae Sook Lee, Jong Uk Won, Dong Bin Song, Eun Hee Ha, Seong Kyu Kang; Korean Journal of Occupational and Environmental Medicine 2001;13(2):101-115. Published online June 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.2.101

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No abstract available.

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Management System of Occupational Diseases in Korea: Statistics, Report and Monitoring System
Kyung Yong Rhee, Seong Weon Choe
Journal of Korean Medical Science.2010; 25(Suppl): S119. CrossRef

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Review

Occupational Disease Surveillance System: Planning and Management: Soo Hun Cho, Yun Chul Hong, Jong Han Leem, Seong Sil Chang, Byung Chul Chun; Korean Journal of Occupational and Environmental Medicine 2001;13(1):10-17. Published online March 31, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.1.10

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No abstract available.

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Management System of Occupational Diseases in Korea: Statistics, Report and Monitoring System
Kyung Yong Rhee, Seong Weon Choe
Journal of Korean Medical Science.2010; 25(Suppl): S119. CrossRef

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Original Article

Contact dermatitis surveillance system in Taejon city: Prevalence of contact dermatitis among the workers exposed to solvents and nonmentallic chemicals through an immediate health examination system in Taejon city: Seong Sil Chang, Sooyoung Kim; Korean Journal of Occupational and Environmental Medicine 2000;12(2):227-234. Published online June 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.2.227

Abstract PDF

OBJECTIVES
We tried to establish a Regional Occupational Surveillance System (ROSS) for estimating the prevalence and monitoring the trend of occupational dermatitis among 718 manufacturing workers exposed to organic solvents and nonmetallic chemicals in small and medium sized businesses of 1,2 industrial complex area of taejon City.
METHODS
Through the report from the nurses of Group Occupational Health Management System, we made a case referral and immediate health examination system with occupational medical clinics. We also performed a survey for detecting occupational dermatitis by a self-administered questionnaire. Case must meet 3 criteria; 1) He/She must have one or more significant cutaneous signs and symptoms. 2) The symptom should be changed by the work condition or caused by risk chemicals. 3) Dermatitis should be diagnosed by a doctor. Results Among the 131 workers(17. 7 %) with significant symptoms screened by the questionnaire, 4 workers(0. 6 %) met the case definition criteria. And among the 45 workers (6. 3 9o) referred to the immediate diagnosed system, 14 workers (l. 9 %) were Strongly suspected to have occupational dermatitis.
CONCLUSIONS
These prevalence rates were quite underestimated because of deficient recognition of the disease severity among the workers, reversibility of the target diseases, and life-threathening mood due to nationwide economic crisis and the socioeconomic withdrawal of each business. Ultimately, harmonized activities of government, industry, labor unions, volunteer organization and academy relating to occupational health in a community should be encouraged to do creative, consistent efforts for evolution and development of this first trial of ROSS.

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Work-relatedness of lung cancer by smoking and histologic type in Korea
Young-Il Lee, Sang-Gil Lee, Dong-Mug Kang, Jong-Eun Kim, Young-Ki Kim, Jong-Han Leem, Hwan-Cheol Kim
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef
Occupational Skin Diseases in Korea
Yeon-Soon Ahn, Min-Gi Kim
Journal of Korean Medical Science.2010; 25(Suppl): S46. CrossRef

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Original Article

Stress Relating Factors of Working Women in a Bank: Kyung Tae Jung, Seong Sil Chang, Kang Sook Lee, Yeon Kyeng Lee, Dong Bae Lee; Korean Journal of Occupational and Environmental Medicine 1999;11(1):95-105. Published online March 31, 1999; DOI: https://doi.org/10.35371/kjoem.1999.11.1.95

Abstract PDF

We surveyed 343 female bank clerks to find out associations between stress and a variety of factors including general, menstruation and reproductive characteristics of the participants. Unmarried women composed the majority of younger, lower income and lower education groups than married did. They also showed higher. though not significantly higher, scores for psychosocial well being index(PWJ) and the first three items of the stress survey. And married women scored slightly higher only in the fourth item of the stress survey. Among the subgroups of married and unmarried women, many factors contributed to a higher stress score in two or more items of the stress survey; in unmarried women, lower education level, little physical exercise, and large family inhabitants, in contrast married women, higher monthly income and greater working hours were related to higher stress scores. According to the menstruation factors, subgroups with dysmenorrhea or irregular cycle and scanty bleedig volume in unmarried women and subgroups with dysmenorrhea in married women showed higher stress scores in PWI. In married women, the proportion of those who have been pregnant was 77.2% and the proportion of those who have experienced spontaneous abortion was 24.1%. Those who have ever experienced two or more spontaneous abortion showed higher, though not statistically significantly higher. scores for PWI. In conclusion, dysmenorrhea was associated with high stress score in two groups. And the other factors related to higher score of PWJ were different between unmarred and married women, which should be considered in a management plan for mental health promotion.

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Work - Family Conflict and Stress: Evidence from Malaysia
Nurnazirah Jamadin, Samsiah Mohamad, Zurwina Syarkawi, Fauziah Noordin
Journal of Economics, Business and Management.2015; 3(2): 309. CrossRef

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Original Article

Effect of Aldehyde dehydrogenase2 (ALDH2) Genotypes in Urinary Hippuric Acid Excretion as a Biological Exposure Index of Toluene: Seong Sil Chang, Chung Yill Park, Kang Sook Lee, Young Man Roh; Korean Journal of Occupational and Environmental Medicine 1996;8(3):454-465. Published online December 31, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.3.454

Abstract PDF

We investigated toluene exposure level, urinary hippuric acid concentrations, subjective symptoms and genotype of ALDH2 DNA in 134 exposed workers and 53 nonexposed workers for evaluating the effect of ALDH2 polymorphism on toluene metabolism and urinary hippuric acid concentration as biological exposure indices (BEI) of toluene. The results were as follows; 1. The percentage of inactive genotype of ALDH2 in exposed workers was lower than that of exposed (P=0.081). 2. The percentages of exposed workers with inactive genotype did not have any significant difference by the increase of toluene exposure level or work duration. 3. The frequency of drinking, monthly and maximum amount of alcohol intake in workers with normal genotype were significantly higher than those with inactive genotype. 4. The urinary hippuric acid concentration of nonexposed workers ,with inactive genotype was significantly lower than that with normal genotype. Under 100 ppm of toluene, similar but statistically insignificant trends were found, while above that concentration of toluene, reverse but statistically insignificant trends were found. 5. The number of acute and chronic subjective symptoms were increased positively with the concentration of toluene in workers with normal genotype, but ho such trends were found in workers with inactive genotype. 6. The result of simple linear regression between toluene and urinary hippuric acid concentrations showed a very significant positive linear relation-ship. The mean hippuric acid concentration of nonoccupational exposure was 0.289+/-0.227 (0.062-0.516) g/l. Toluene exposure level unable to discriminate with nonoccupational exposure estimated from regression equation, it range from 7.29 to 9.87 ppm. Considering above all things, it was useful to estimate the exposure level of toluene by means of analysing urinary hippuric acid concentration in both genotype workers, but the biological exposure indices (BEI) of both genotypes were different from each other. The BEI of the total exposed workers was 2.76 g/ I, which was lower than current criteria 3.0g/ I (2.5 g/g Cr), and it also suggest that the BEI for the exposed workers in our country be lowered to the appropriate level after further study.

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Effects of Factors Associated with Urine Hippuric Acid Correction Values in Urinary Creatinine by HPLC and Jaffe Method and Specific Gravity HPLC Jaffe Method
Key-Young Kim, Jong-Gyu Kim, Ki-Nam Yoon, Wha-Me Park, Hun-Hee Park
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 493. CrossRef

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Original Article

Performances of the WHO Neurobehavioral Core Test Battery among Mal Workers Occupationally Non-exposed to Neurotoxic Agents: Se Hoon Lee, Hyoung Ah Kim, Won Chul Lee, Seong Sil Chang, Kyung Jae Lee, Chung Yill Park, Chee Kyung Chung; Korean Journal of Occupational and Environmental Medicine 1995;7(1):139-151. Published online February 28, 1995; DOI: https://doi.org/10.35371/kjoem.1995.7.1.139

Abstract PDF: Five items among neurobehavioral core test battery of World Health Organization, including Santa Ana dexterity, pursuit aiming, digit symbol, simple reaction time, and Benton visual retention, were administered to the workers occupationally non-exposed to neurotoxic agents by operational guide for the WHO neurobehavioral core test battery. Subjects were volunteers from the industrial workers (117) and clerks (40). Detailed occupational history such as exposed agents including noise or vibration, educational level, residence, smoking and drinking habit were recorded. Most of the neurobehavioral tests were correlated with age and educational level. Smoking was correlated with pursuit aiming and digit symbol. Vibration affected pursuit aiming. Job type (industrial workers vs. clerks) and noise exposure did not affected among tested items. Multiple regression analysis was done for establishing predict equation to estimate normal ranges of the tests for male workers. Age was shown to be main independent variable affected for all tests except wrong dot of pursuit aiming. Educational level was also shown to affected most of the tests except Santa ana dexterity and wrong dot of pursuit aiming. Alcohol consumption affected Santa Ana dexterity, non-preferred hand, and smoking affected only wrong dot of pursuit aiming after multiple regression analysis.

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Original Article

Current Medical Exantination Practiees for the Determination of Occupational Noise Induced Hearing Losses: Hyunurook Kim, Chee Kyung Chung, Hyoung Ah Kim, Young Man Roh, Seong Sil Chang; Korean Journal of Occupational and Environmental Medicine 1994;6(2):276-288. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.276

Abstract PDF: Occupational hearing loss became the leading occupational disease by constituting 56% of all work-related diseases in Korea. However, the prevalence rates showed wide variations among the specific medical examination providers (SHFEPs) and were very low (0.8-1.4%) compared with those of 8.4% in Japan. This study was designed to identify sources of these variations by inyestigating current audiometric testing methods and the diagnostic criteria utilized by the ShfEPs. A questionnaire was distributed to each of 27 SMEPS selected from total 70 SMEPS. Among them, 20 ShfEPs were interviewed and the rest of them were given the questionnaire from by mail. Included in the survey from were questions concerning audiometric testing methods and procedure equipment, facility personnel and the diagnostic criteria utilized, The results were as follows: 1. Employee audiometric testings were primaTily conducted by nurses and nurse-aids who had formal training for audiometry because no training program had been established. No requirement about the quality of audiometric testing personnel was specified in the regulation. 2. Although audiometric testing equipment used by the SDfEPs should be periodically calibrated, a significant number of them were not properly calibrated. Most of the calibration services were provided by the outside contractors and were done with no uniformly established periods. No SMEPS conducted the daily functional calibration. Most of the ShfEPs did not keep their calibration records. 3. Initial audiometric testings were conducted at any available spaces in the workplace or at the testing room without considering noise level in that place. Follow-up audiometric testings were also provided without considering the worker's noise exposure. Although audiometric booths were used during tHe follow-up testinga most of them did not meet the ANSI noise reauirement for audiometric booths. 4. AltHough a standard diagnostic criterion was promulgated in the law, the criterion was not used uniffrmly by the SMEPs. In addition, some SMEPS were applying age corrections which were not incorporated into the regulation yet. Therefore wide range of prevalence in NIHU among SMEPS could have possibly been caused by variable audiometric testing procedures and methods. In conclusion, it was recommended that systematical and general measures, such as formal and regular training program for testers, quality control regulation of instnlment calibration, and establishment of standard diagnostic criteria, be established for solving current problems and assuring equity among SMEPs in diagnosing occupational hearing losses.

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